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Medications are used to reverse the symptoms of extrapyramidal side effects caused by antipsychotics or other drugs, by either directly or indirectly increasing dopaminergic neurotransmission. The treatment varies by the type of the EPS, but may involve anticholinergic agents such as procyclidine, benztropine, diphenhydramine, and trihexyphenidyl.
Oculogyric crisis (OGC) is a rare sudden, paroxysmal, dystonic reaction that may manifest in response to specific drugs, particularly neuroleptics, or medical conditions, such as movement disorders. This neurological phenomenon is characterized by a sustained dystonic, conjugate, involuntary upward deviation of both eyes lasting seconds to hours.
Recently, the procedure of deep brain stimulation (DBS) has proven successful in a number of cases of severe generalised dystonia. [43] DBS as treatment for medication-refractory dystonia, on the other hand, may increase the risk of suicide in patients. However, reference data of patients without DBS therapy are lacking. [44]
Biperiden is also commonly used to improve acute extrapyramidal side effects related to antipsychotic drug therapy, such as akathisia. It relieves muscle rigidity , reduces abnormal sweating related with clozapine and methadone use [ 9 ] [ 10 ] and salivation , improves abnormal gait , and to lesser extent, tremor .
Status dystonicus, also known as dystonic storm, is a serious and potentially life-threatening disorder which occurs in people who have primary or secondary dystonia. Symptoms consist of widespread severe muscle contractions.
Diphenhydramine is effective in the treatment of allergies. [22] As of 2007 [update] , it was the most commonly used antihistamine for acute allergic reactions in the emergency department. [ 23 ]
Acute dystonia nearly always develops a few weeks after a dopamine blocking agent/medication has begun or a substantial increase in antipsychotic dosage. An acute dystonic reaction consists of sustained, painful muscular spasms, producing twisting of the trunk/body and abnormal posture.
Sedation is very common, and extrapyramidal side effects are common and include restlessness, dystonic reactions, pseudoparkinsonism, and akathisia; the extrapyramidal symptoms can affect 2% of people at low doses, whereas higher doses may affect as many as 40% of people. [18] [19]